Osteograft implant

ABSTRACT

Bone implant compositions are provided that include a body made of cortical bone extending along an axis between a first end and a second end. The body includes an outer surface configured to engage host bone of a patient and at least one recess extending transverse to the axis into the outer surface of the body configured for disposal of an insert. At least one insert made of demineralized bone is disposed in the at least one recess.

BACKGROUND

The rapid and effective repair of bone defects caused by injury,disease, wounds, or surgery is a goal of orthopedic surgery. Toward thisend, a number of bone implants have been used or proposed for use in therepair of bone defects. The biological, physical, and mechanicalproperties of the bone implants are among the major factors influencingtheir suitability and performance in various orthopedic applications.

Bone implants, such as, for example, osteografts, are used to repairbone that has been damaged by disease, trauma, or surgery. Bone implantsmay be utilized when healing is impaired in the presence of certaindrugs or in disease states such as diabetes, when a large amount of boneor disc material is removed during surgery, or when bone fusion isneeded to create stability. In some types of spinal fusion, for example,bone implants are used to replace the cushioning disc material betweenthe vertebrae or to repair a degenerative facet joint.

One type of bone implant is an osteograft. Typically, bone graft (e.g.,osteograft) materials may include both synthetic and natural bone.Natural bone may be taken from the graft recipient (autograft) or may betaken from another source (allograft), such as a cadaver, or(xenograft), such as bovine. Autografts have advantages such asdecreased immunogenicity and greater osteoinductive potential, but therecan also be problems with donor site morbidity and limited supply ofsuitable bone for grafting. On the other hand, allografts are availablein greater supply and can be stored for years. However, allografts tendto be less osteoinductive.

Osteoconduction and osteoinduction both contribute to bone formation. Agraft material is osteoconductive if it provides a structural frameworkor microscopic and macroscopic scaffolding for cells and cellularmaterials that are involved in bone formation (e.g., osteoclasts,osteoblasts, vasculature, mesenchymal cells).

Osteoinductive material, on the other hand, stimulates differentiationof host mesenchymal cells into chondroblasts and osteoblasts. Naturalbone osteograft materials can comprise either cortical or cancellousbone. A distinguishing feature of cancellous bone is its high level ofporosity relative to that of cortical bone, providing more free surfacesand more of the cellular constituents that are retained on thesesurfaces. It provides both an osteoinductive and osteoconductive graftmaterial, but generally does not have significant load-bearing capacity.Optimal enhancement of bone formation is generally thought to require aminimum threshold quantity of cancellous bone, however. Cortical(compact) bone has greater strength or load-bearing capacity thancancellous bone, but is less osteoconductive. In humans for example,only approximately twenty percent of large cortical allografts arecompletely incorporated at five years. Delayed or incompleteincorporation may allow micromotion, leading to host bone resorptionaround the osteograft. A more optimal bone graft material would combinesignificant load-bearing capacity with both osteoinductive andosteoconductive properties and much effort has been directed towarddeveloping such a graft material.

Some osteografts comprise mammalian cadaver bone treated to remove allsoft tissue, including marrow and blood, and then textured to form amultiplicity of holes of selected size, spacing, and depth. The texturedbone section is then immersed and demineralized, for example, in adilute acid bath. Demineralizing the bone exposes osteoinductivefactors, but extensive demineralization of bone also decreases itsmechanical strength.

Osteografts have also been formed of organic bone matrix withperforations that extend from one surface, through the matrix, to theother surface to provide continuous channels between opposite surfaces.The organic bone matrix is produced by partial or completedemineralization of natural bone. Although the perforations increase thescaffolding potential of the graft material and may be filled withosteoinductive material as well, perforating organic bone matrix throughthe entire diameter of the graft decreases its load-bearing capacity.

What is needed is an osteograft that combines the osteoinductive andosteoconductive properties of demineralized bone with the load-bearingcapacity provided by cortical osteograft materials. Compositions andmethods are needed that facilitate bone remodeling and new bone growth,and integration of the osteograft into host bone.

SUMMARY

In some embodiments, in accordance with the principles of the presentdisclosure, an osteograft is provided that facilitates bone remodelingand new bone growth, and integration into host bone. The osteograftincludes a body comprising cortical bone extending along an axis betweena first end and a second end. The body of the osteograft has an outersurface configured to engage host bone of a patient. The body includesat least one recess extending transverse to the axis into the outersurface configured for disposal of an insert. The osteograft includes atleast one insert comprising demineralized bone disposed in the at leastone recess to initiate the bone fusion process and provide rapid bonebonding to the osteograft. The osteograft of the current application, insome embodiments, is load bearing and provides good mechanical strength.

In some embodiments, in accordance with the principles of the presentdisclosure, an osteograft is provided that includes a body comprisingcortical bone extending between a first end and a second end along anaxis. The body of the osteograft includes an outer surface configured toengage host bone of a patient. The body has an upper surface and a lowersurface opposite the upper surface and includes an inner surfacedefining an opening extending through the upper and lower surfaces. Theupper and lower surfaces each have a plurality of recesses each having acircular cross-sectional configuration and extending perpendicular tothe axis into the outer surface disposed circumferentially about theupper and lower surfaces. The inner surface of the body further includesa plurality of recesses each having a circular cross-sectionalconfiguration and extending parallel to the axis. A plurality of plugscomprising demineralized bone each having a square cross-sectionalconfiguration are disposed in one of the recesses in the osteograftbody. The inner and outer surfaces of the osteograft body are surfacedemineralized before the plugs are disposed into the recesses to promotechemical or cohesive bonding or mechanical press fit between the bodyand the plugs.

In some embodiments, in accordance with the principles of the presentdisclosure, a kit is provided that includes an osteograft having a bodycomprising cortical bone extending between a first end and a second endalong an axis. The osteograft includes an outer surface configured toengage host bone of a patient. The body of the osteograft includes upperand lower surfaces and an inner surface defining an opening extendingthrough the upper and lower surfaces. The upper and lower surfaces eachhave a plurality of recesses extending transverse to the axis into theouter surface. The inner surface has a plurality of recesses extendingparallel to the axis into the inner surface. Each of the recesses have acircular cross-sectional configuration. The kit includes a plurality ofplugs comprising demineralized bone and having a polygonalcross-sectional configuration configured for disposal in one of therecesses in the body of the osteograft. The kit further includes aplurality of plugs comprising demineralized bone and having a circularcross-sectional configuration configured for disposal in one of therecesses in the body of the osteograft.

Additional features and advantages of various embodiments will be setforth in part in the description that follows, and in part will beapparent from the description, or may be learned by practice of variousembodiments. The objectives and other advantages of various embodimentswill be realized and attained by means of the elements and combinationsparticularly pointed out in the description and appended claims.

BRIEF DESCRIPTION OF THE FIGURES

In part, other aspects, features, benefits and advantages of theembodiments will be apparent with regard to the following description,appended claims and accompanying drawings where:

FIG. 1A illustrates a top view of one embodiment of an osteograft inaccordance with the principles of the present disclosure.

FIG. 1B illustrates a bottom view of the osteograft shown in FIG. 1A.

FIG. 1C illustrates a side cross sectional view of the osteograft shownin FIG. 1A.

FIG. 1D illustrates a side cross sectional view of the osteograft shownin FIG. 1A.

FIG. 2A illustrates a side cross sectional view of one embodiment of aninner surface of the osteograft shown in FIG. 1A.

FIG. 2B illustrates a side cross sectional view of one embodiment of aninner surface of the osteograft shown in FIG. 1A.

FIG. 2C illustrates a side cross sectional view of one embodiment of aninner surface of the osteograft shown in FIG. 1A.

FIG. 3A illustrates a side cross sectional view of one embodiment of aninner surface of the osteograft shown in FIG. 1A.

FIG. 3A illustrates a side cross sectional view of one embodiment of aninner surface of the osteograft shown in FIG. 1A.

FIG. 3C illustrates a side cross sectional view of one embodiment of aninner surface of the osteograft shown in FIG. 1A.

FIG. 4A illustrates a perspective view of one embodiment of an insert ofthe osteograft shown in FIG. 1A in accordance with the principles of thepresent disclosure.

FIG. 4B illustrates a top view of the insert shown in FIG. 10A.

FIG. 5 illustrates the insert shown in FIG. 10A positioned within arecess of the osteograft shown in FIG. 1A.

FIG. 6A illustrates a perspective view of one embodiment of an insert ofthe osteograft shown in FIG. 1A in accordance with the principles of thepresent disclosure.

FIG. 6B illustrates a top view of the insert shown in FIG. 11A.

FIG. 7A illustrates a side view of one embodiment of an insert of theosteograft shown in FIG. 1A in accordance with the principles of thepresent disclosure.

FIG. 7B illustrates a side view of the insert shown in FIG. 12A.

FIG. 8A illustrates a top view of one embodiment of an osteograft inaccordance with the principles of the present disclosure.

FIG. 8B illustrates a bottom view of the osteograft shown in FIG. 8A.

FIG. 8C illustrates a side cross sectional view of the osteograft shownin FIG. 8A.

FIG. 8D illustrates a side cross sectional view of the osteograft shownin FIG. 8A.

FIG. 9A illustrates a top view of one embodiment of an osteograft inaccordance with the principles of the present disclosure.

FIG. 9B illustrates a bottom view of the osteograft shown in FIG. 9A.

FIG. 9C illustrates a side cross sectional view of the osteograft shownin FIG. 9A.

FIG. 9D illustrates a side cross sectional view of the osteograft shownin FIG. 9A.

FIG. 10A illustrates a top view of one embodiment of an osteograft inaccordance with the principles of the present disclosure.

FIG. 10B illustrates a bottom view of the osteograft shown in FIG. 10A.

FIG. 10C illustrates a side cross sectional view of the osteograft shownin FIG. 10A.

FIG. 10D illustrates a side cross sectional view of the osteograft shownin FIG. 10A.

FIG. 11A illustrates a top view of one embodiment of an osteograft inaccordance with the principles of the present disclosure.

FIG. 11B illustrates a bottom view of the osteograft shown in FIG. 11A.

FIG. 11C illustrates a side cross sectional view of the osteograft shownin FIG. 11A.

FIG. 11D illustrates a side cross sectional view of the osteograft shownin FIG. 11A.

FIG. 12A illustrates a top view of one embodiment of an osteograft inaccordance with the principles of the present disclosure.

FIG. 12B illustrates a bottom view of the osteograft shown in FIG. 12A.

FIG. 12C illustrates a side cross sectional view of the osteograft shownin FIG. 12A.

FIG. 12D illustrates a side cross sectional view of the osteograft shownin FIG. 12A.

FIG. 13A illustrates a top view of one embodiment of an osteograft inaccordance with the principles of the present disclosure.

FIG. 13B illustrates a bottom view of the osteograft shown in FIG. 13A.

FIG. 13C illustrates a side cross sectional view of the osteograft shownin FIG. 13A.

FIG. 13D illustrates a side cross sectional view of the osteograft shownin FIG. 13A.

It is to be understood that the figures are not drawn to scale. Further,the relation between objects in a figure may not be to scale, and may infact have a reverse relationship as to size. The figures are intended tobring understanding and clarity to the structure of each object shown,and thus, some features may be exaggerated in order to illustrate aspecific feature of a structure.

DETAILED DESCRIPTION

For the purposes of this specification and appended claims, unlessotherwise indicated, all numbers expressing quantities of ingredients,percentages or proportions of materials, reaction conditions, and othernumerical values used in the specification and claims, are to beunderstood as being modified in all instances by the term “about.”Accordingly, unless indicated to the contrary, the numerical parametersset forth in the following specification and attached claims areapproximations that may vary depending upon the desired propertiessought to be obtained by the present application. At the very least, andnot as an attempt to limit the application of the doctrine ofequivalents to the scope of the claims, each numerical parameter shouldat least be construed in light of the number of reported significantdigits and by applying ordinary rounding techniques.

Notwithstanding that the numerical ranges and parameters setting forththe broad scope of the invention are approximations, the numerical areas precise as possible. Any numerical value, however, inherentlycontains certain errors necessarily resulting from the standarddeviation found in their respective testing measurements. Moreover, allranges disclosed herein are to be understood to encompass any and allsubranges subsumed therein. For example, a range of “1 to 10” includesany and all subranges between (and including) the minimum value of 1 andthe maximum value of 10, that is, any and all subranges having a minimumvalue of equal to or greater than 1 and a maximum value of equal to orless than 10, e.g., 5.5 to 10.

Additionally, unless defined otherwise or apparent from context, alltechnical and scientific terms used herein have the same meanings ascommonly understood by one of ordinary skill in the art to which thisinvention belongs.

Unless explicitly stated or apparent from context, the following termsare phrases have the definitions provided below:

DEFINITIONS

It is noted that, as used in this specification and the appended claims,the singular forms “a,” “an,” and “the,” include plural referents unlessexpressly and unequivocally limited to one referent. Thus, for example,reference to “an osteograft” includes one, two, three or moreosteografts.

The term “biodegradable” includes that all or parts of the implantand/or osteograft will degrade over time by the action of enzymes, byhydrolytic action and/or by other similar mechanisms in the human body.In various embodiments, “biodegradable” includes that the implant and/orosteograft can break down or degrade within the body to non-toxiccomponents after or while a therapeutic agent has been or is beingreleased. By “bioerodible” it is meant that the implant and/orosteograft will erode or degrade over time due, at least in part, tocontact with substances found in the surrounding tissue, fluids or bycellular action. By “bioabsorbable” or “bioresorbable” it is meant thatthe implant and/or osteograft will be broken down and absorbed withinthe human body, for example, by a cell or tissue. “Biocompatible” meansthat the osteograft will not cause substantial tissue irritation ornecrosis at the target tissue site.

The term “mammal” refers to organisms from the taxonomy class“mammalian,” including but not limited to humans, other primates such aschimpanzees, apes, orangutans and monkeys, rats, mice, cats, dogs, cows,horses, etc.

“A “therapeutically effective amount” or “effective amount” is such thatwhen administered, the drug (e.g., growth factor) results in alterationof the biological activity, such as, for example, promotion of bone,cartilage and/or other tissue (e.g., vascular tissue) growth, inhibitionof inflammation, reduction or alleviation of pain, improvement in thecondition through inhibition of an immunologic response, etc. The dosageadministered to a patient can be as single or multiple doses dependingupon a variety of factors, including the drug's administeredpharmacokinetic properties, the route of administration, patientconditions and characteristics (sex, age, body weight, health, size,etc.), extent of symptoms, concurrent treatments, frequency of treatmentand the effect desired. In some embodiments the osteograft is designedfor immediate release of biological agents, such as, for example, bonegrowth materials. In other embodiments the osteograft is designed forsustained release. In other embodiments, the osteograft comprises one ormore immediate release surfaces and one or more sustained releasesurfaces.

The terms “treating” and “treatment” when used in connection with adisease or condition refer to executing a protocol that may include abone repair procedure, where the osteograft and/or one or more drugs areadministered to a patient (human, other normal or otherwise or othermammal), in an effort to alleviate signs or symptoms of the disease orcondition or immunological response. Alleviation can occur prior tosigns or symptoms of the disease or condition appearing, as well asafter their appearance. Thus, treating or treatment includes preventingor prevention of disease or undesirable condition. In addition,treating, treatment, preventing or prevention do not require completealleviation of signs or symptoms, does not require a cure, andspecifically includes protocols that have only a marginal effect on thepatient.

The term “bone,” as used herein, refers to bone that is cortical,cancellous or corticocancellous of autogenous, allogenic, xenogenic, ortransgenic origin.

The term “allograft” refers to a graft of tissue obtained from a donorof the same species as, but with a different genetic make-up from, therecipient, as a tissue transplant between two humans.

The term “autologous” refers to being derived or transferred from thesame individual's body, such as for example an autologous bone marrowtransplant.

The term “osteoconductive,” as used herein, refers to the ability of anon-osteoinductive substance to serve as a suitable template orsubstance along which bone may grow.

The term “osteoinductive,” as used herein, refers to the quality ofbeing able to recruit cells from the host that have the potential tostimulate new bone formation. Any material that can induce the formationof ectopic bone in the soft tissue of an animal is consideredosteoinductive.

The term “osteoinduction” refers to the ability to stimulate theproliferation and differentiation of pluripotent mesenchymal stem cells(MSCs). In endochondral bone formation, stem cells differentiate intochondroblasts and chondrocytes, laying down a cartilaginous ECM, whichsubsequently calcifies and is remodeled into lamellar bone. Inintramembranous bone formation, the stem cells differentiate directlyinto osteoblasts, which form bone through direct mechanisms.Osteoinduction can be stimulated by osteogenic growth factors, althoughsome ECM proteins can also drive progenitor cells toward the osteogenicphenotype.

The term “osteoconduction” refers to the ability to stimulate theattachment, migration, and distribution of vascular and osteogenic cellswithin the graft material. The physical characteristics that affect thegraft's osteoconductive activity include porosity, pore size, andthree-dimensional architecture. In addition, direct biochemicalinteractions between matrix proteins and cell surface receptors play amajor role in the host's response to the graft material.

The term “osteogenic” refers to the ability of a graft material toproduce bone independently. To have direct osteogenic activity, thegraft must contain cellular components that directly induce boneformation. For example, an osteograft seeded with activated MSCs wouldhave the potential to induce bone formation directly, withoutrecruitment and activation of host MSC populations. Because manyosteoconductive osteografts also have the ability to bind and deliverbioactive molecules, their osteoinductive potential will be greatlyenhanced.

The term “osteograft” or “osteoimplant,” as used herein, refers to anybone-derived implant prepared in accordance with the embodiments of thisdisclosure and therefore is intended to include expressions such as bonemembrane, bone graft, etc.

The term “patient” refers to a biological system to which a treatmentcan be administered. A biological system can include, for example, anindividual cell, a set of cells (e.g., a cell culture), an organ, or atissue. Additionally, the term “patient” can refer to animals,including, without limitation, humans.

The term “xenograft” refers to tissue or organs from an individual ofone species transplanted into or grafted onto an organism of anotherspecies, genus, or family.

The term “demineralized,” as used herein, refers to any materialgenerated by removing mineral material from tissue, e.g., bone tissue.In certain embodiments, the demineralized compositions described hereininclude preparations containing less than 5% calcium and preferably lessthan 1% calcium by weight. Partially demineralized bone (e.g.,preparations with greater than 5% calcium by weight but containing lessthan 100% of the original starting amount of calcium) is also consideredwithin the scope of the disclosure. In some embodiments, demineralizedbone has less than 95% of its original mineral content. Demineralized isintended to encompass such expressions as “substantially demineralized,”“partially demineralized,” and “fully demineralized.” In someembodiments, part or all of the surface of the bone can bedemineralized. For example, part or all of the surface of a corticalosteograft can be demineralized to a depth of from about 100 to about5000 microns, or about 150 microns to about 1000 microns. If desired,the outer surface of the osteograft can be masked with an acid resistantcoating or otherwise treated to selectively demineralize unmaskedportions of the outer surface of the osteograft so that the surfacedemineralization is at discrete positions on the osteograft.

The term “demineralized bone matrix,” as used herein, refers to anymaterial generated by removing mineral material from bone tissue. Insome embodiments, the DBM compositions as used herein includepreparations containing less than 5% calcium and preferably less than 1%calcium by weight. Partially demineralized bone (e.g., preparations withgreater than 5% calcium by weight but containing less than 100% of theoriginal starting amount of calcium) are also considered within thescope of the disclosure.

The term “superficially demineralized,” as used herein, refers tobone-derived elements possessing at least about 90 weight percent oftheir original inorganic mineral content, the expression “partiallydemineralized” as used herein refers to bone-derived elements possessingfrom about 8 to about 90 weight percent of their original inorganicmineral content and the expression “fully demineralized” as used hereinrefers to bone containing less than 8% of its original mineral context.

The terms “pulverized bone”, “powdered bone” or “bone powder” as usedherein, refers to bone particles of a wide range of average particlesize ranging from relatively fine powders to coarse grains and evenlarger chips.

The osteograft can comprise bone fibers. Fibers include bone elementswhose average length to average thickness ratio or aspect ratio of thefiber is from about 50:1 to about 1000:1. In overall appearance thefibrous bone elements can be described as elongated bone fibers,threads, narrow strips, or thin sheets. Often, where thin sheets areproduced, their edges tend to curl up toward each other. The fibrousbone elements can be substantially linear in appearance or they can becoiled to resemble springs. In some embodiments, the elongated bonefibers are of irregular shapes including, for example, linear,serpentine or curved shapes. The elongated bone fibers are preferablydemineralized however some of the original mineral content may beretained when desirable for a particular embodiment.

Non-fibrous, as used herein, refers to elements that have an averagewidth substantially larger than the average thickness of the fibrousbone element or aspect ratio of less than from about 50:1 to about1000:1. In some embodiments, the non-fibrous bone elements are shaped ina substantially regular manner or specific configuration, for example,triangular prism, sphere, cube, cylinder and other regular shapes. Bycontrast, particles such as chips, shards, or powders possess irregularor random geometries. It should be understood that some variation indimension will occur in the production of the elements of thisapplication and elements demonstrating such variability in dimension arewithin the scope of this application and are intended to be understoodherein as being within the boundaries established by the expressions“mostly irregular” and “mostly regular”.

Reference will now be made in detail to certain embodiments of theinvention. While the invention will be described in conjunction with theillustrated embodiments, it will be understood that they are notintended to limit the invention to those embodiments. On the contrary,the invention is intended to cover all alternatives, modifications, andequivalents that may be included within the invention as defined by theappended claims.

The headings below are not meant to limit the disclosure in any way;embodiments under any one heading may be used in conjunction withembodiments under any other heading.

Osteograft

Osteografts, such as, for example, osteograft 30 are provided thatfacilitate bone remodeling and new bone growth, and integration of thebone implant (e.g., osteograft) into host bone. In some embodiments, theosteograft provides an improved surface between the dense corticalosteograft and a patient's host bone to facilitate incorporation of theosteograft construct and fusion to host bone. In some embodiments, theosteograft comprises includes recesses extending into an outer surfaceof the osteograft having inserts comprising demineralized bone insertedinto the recesses to initiate the bone fusion process at the osteograftsurface and provide rapid bone bonding to the cortical osteograft. Theosteograft of the current application, in some embodiments, is loadbearing and provides good mechanical strength.

Osteograft 30 includes a body having a substantially rectangularconfiguration comprising cortical bone extending along an axis a betweena first end 32 and a second end 34. In addition to bone, such as, forexample, cortical bone, osteograft 30 may comprise natural and/orsynthetic materials. For example, osteograft 30 may comprise poly(alpha-hydroxy acids), poly (lactide-co-glycolide) (PLGA), polylactide(PLA), polyglycolide (PG), polyethylene glycol (PEG) conjugates of poly(alpha-hydroxy acids), polyorthoesters (POE), polyaspirins,polyphosphagenes, collagen, hydrolyzed collagen, gelatin, hydrolyzedgelatin, fractions of hydrolyzed gelatin, elastin, starch,pre-gelatinized starch, hyaluronic acid, chitosan, alginate, albumin,fibrin, vitamin E analogs, such as alpha tocopheryl acetate, d-alphatocopheryl succinate, D,L-lactide, or L-lactide, -caprolactone,dextrans, vinylpyrrolidone, polyvinyl alcohol (PVA), PVA-g-PLGA,PEGT-PBT copolymer (polyactive), methacrylates, poly(N-isopropylacrylamide), PEO-PPO-PEO (pluronics), PEO-PPO-PAAcopolymers, PLGA-PEO-PLGA, PEG-PLG, PLA-PLGA, poloxamer 407,PEG-PLGA-PEG triblock copolymers, SAIB (sucrose acetate isobutyrate),polydioxanone, methylmethacrylate (MMA), MMA and N-vinylpyyrolidone,polyamide, oxycellulose, copolymer of glycolic acid and trimethylenecarbonate, polyesteramides, polyetheretherketone,polymethylmethacrylate, or combinations thereof.

In some embodiments, osteograft 30 may comprise a resorbable ceramic(e.g., hydroxyapatite, tricalcium phosphate, bioglasses, calciumsulfate, etc.) tyrosine-derived polycarbonate poly(DTE-co-DT carbonate),in which the pendant group via the tyrosine—an amino acid—is either anethyl ester (DTE) or free carboxylate (DT) or combinations thereof.

In some embodiments, osteograft 30 may comprises collagen. Exemplarycollagens include human or non-human (bovine, ovine, and/or porcine), aswell as recombinant collagen or combinations thereof. Examples ofsuitable collagen include, but are not limited to, human collagen typeI, human collagen type II, human collagen type III, human collagen typeIV, human collagen type V, human collagen type VI, human collagen typeVII, human collagen type VIII, human collagen type IX, human collagentype X, human collagen type XI, human collagen type XII, human collagentype XIII, human collagen type XIV, human collagen type XV, humancollagen type XVI, human collagen type XVII, human collagen type XVIII,human collagen type XIX, human collagen type XXI, human collagen typeXXII, human collagen type XXIII, human collagen type XXIV, humancollagen type XXV, human collagen type XXVI, human collagen type XXVII,and human collagen type XXVIII, or combinations thereof. Collagenfurther may comprise hetero- and homo-trimers of any of theabove-recited collagen types. In some embodiments, the collagencomprises hetero- or homo-trimers of human collagen type I, humancollagen type II, human collagen type III, or combinations thereof.

Osteograft 30 may contain an inorganic material, such as an inorganicceramic and/or bone substitute material. Exemplary inorganic materialsor bone substitute materials include but are not limited to aragonite,dahlite, calcite, amorphous calcium carbonate, vaterite, weddellite,whewellite, struvite, urate, ferrihydrate, francolite, monohydrocalcite,magnetite, goethite, dentin, calcium carbonate, calcium sulfate, calciumphosphosilicate, sodium phosphate, calcium aluminate, calcium phosphate,hydroxyapatite, alpha-tricalcium phosphate, dicalcium phosphate,β-tricalcium phosphate, tetracalcium phosphate, amorphous calciumphosphate, octacalcium phosphate, BIOGLASS™, fluoroapatite,chlorapatite, magnesium-substituted tricalcium phosphate, carbonatehydroxyapatite, substituted forms of hydroxyapatite (e.g.,hydroxyapatite derived from bone may be substituted with other ions suchas fluoride, chloride, magnesium sodium, potassium, etc.), orcombinations or derivatives thereof.

In some embodiments, osteograft 30 has a density of between about 1.6g/cm³, and about 0.05 g/cm³. In some embodiments, osteograft 30 has adensity of between about 1.1 g/cm³, and about 0.07 g/cm³. For example,the density may be less than about 1 g/cm³, less than about 0.7 g/cm³,less than about 0.6 g/cm³, less than about 0.5 g/cm³, less than about0.4 g/cm³, less than about 0.3 g/cm³, less than about 0.2 g/cm³, or lessthan about 0.1 g/cm³.

The shape of osteograft 30 may be tailored to the site at which it is tobe situated. For example, it may be in the shape of a morsel, a plug, apin, a peg, a cylinder, a block, a wedge, ring, a sheet, etc. In someembodiments, osteograft 30 is H-shaped for placement between the spinousprocess.

In some embodiments, osteograft 30 may be made by injection molding,compression molding, blow molding, thermoforming, die pressing, slipcasting, electrochemical machining, laser cutting, water-jet machining,electrophoretic deposition, powder injection molding, sand casting,shell mold casting, lost tissue scaffold casting, plaster-mold casting,ceramic-mold casting, investment casting, vacuum casting, permanent-moldcasting, slush casting, pressure casting, die casting, centrifugalcasting, squeeze casting, rolling, forging, swaging, extrusion,shearing, spinning, powder metallurgy compaction or combinationsthereof.

The body of osteograft 30 includes parallel side walls 36, 38 extendingbetween ends 32, 34 on opposite sides of osteograft 30. The body ofosteograft 30 includes a first end wall 40 at end 32 extending betweenside walls 36, 38 and a second end wall 42 at end 34 extending betweenside walls 36, 38. End walls 40, 42 are parallel to one another. Thebody of osteograft 30 further includes a top surface 44 and a bottomsurface 46 opposite surface 44 each extending transverse to axis a.Surfaces 44, 46 are parallel to one another. It is envisioned thatosteograft 30 may have alternate cross section configurations, such as,for example, oval, oblong, triangular, square, hexagonal, polygonal,irregular, uniform, non-uniform and/or tapered. It is further envisionedthat side walls 36, 38 and/or end walls 40, 42 and/or surfaces 44, 46may be disposed at alternate orientations, relative to one another, suchas, for example, transverse and/or other angular orientations such asacute or obtuse, according to the requirements of a particularapplication. It is contemplated that the body of the graft is notdemineralized in order to provide structural support.

In some embodiments, corners of osteograft 30 between side wall 36 andend wall 40, between side wall 36 and end wall 42, between side wall 38and end wall 40 and between side wall 38 and end wall 42 are rounded tofacilitate insertion of osteograft 30 into a patient, such as, forexample, between adjacent vertebrae, without damaging tissue or otherportions of the patient's anatomy. It is envisioned that corners ofosteograft 30 between side wall 36 and end wall 40, between side wall 36and end wall 42, between side wall 38 and end wall 40 and between sidewall 38 and end wall 42 may be non-rounded, depending upon therequirements of a particular application.

In some embodiments, osteograft 30 includes an inner surface 48 defininga passage 50 extending through top and bottom surfaces 44, 46. Passage50 has a substantially rectangular cross sectional configuration definedby parallel side walls 52, 54 extending between parallel end walls 56,58. It is envisioned that passage 50 may have alternate cross sectionconfigurations, such as, for example, circular, oval, oblong,triangular, square, hexagonal, polygonal, irregular, uniform,non-uniform and/or tapered. It is further envisioned that side walls 52,54 and/or end walls 56, 58 may be disposed at alternate orientations,relative to one another, such as, for example, transverse and/or otherangular orientations such as acute or obtuse, according to therequirements of a particular application. It is further envisioned thatpassage 50 may have alternate cross section configurations, such as, forexample, oval, oblong, triangular, square, hexagonal, polygonal,irregular, uniform, non-uniform and/or tapered.

The body of osteograft 30 has an outer surface configured to engage hostbone of a patient. The body includes at least one recess 60 extendingtransverse to axis a into the outer surface of osteograft 30 configuredfor disposal of an insert, such as, for example a plug 62 comprisingdemineralized bone to initiate the bone fusion process and bone bonding.That is, plugs 62 provide a sufficient amount of osteoinductive and/orosteoconductive material, such as, for example, demineralized bonematrix, to initiate the fusion process at an interface betweenosteograft 30 and plugs 62 to promote rapid bone bonding to osteograft30.

Recesses 60 may be drilled or machined into selected portions ofosteograft 30. Recesses 60 have a circular cross sectional configurationand extend transverse to axis a. Osteograft 30 includes a plurality ofspaced apart recesses 60 in top surface 44 (FIG. 1A) and a plurality ofspaced apart recesses 60 in bottom surface 46 (FIG. 1B). Recesses 60 areuniformly distributed on top surface 44 and bottom surface 46. Inparticular, osteograft 30 includes a recess 60 in corners of top andbottom surfaces 44, 46 between side wall 36 and end wall 40, betweenside wall 36 and end wall 42, between side wall 38 and end wall 40 andbetween side wall 38 and end wall 42 such that recesses 60 in topsurface 44 are coaxial with recesses 60 in bottom surface 46 (FIGS. 1Cand 1D). It is envisioned that top surface 44 may include one or aplurality of recesses 60 that are each coaxial with an equal number ofrecesses 60 in bottom surface 46. This configuration allows for a plug62 comprising a material, such as, for example, demineralized boneinserted into recesses 60 to simultaneously distribute osteoconductiveand/or osteoinductive material in the same amount and manner from topsurface 44 as bottom surface 46. It is further envisioned that recesses60 may be disposed in top surface 44 and/or bottom surface 46 atalternate orientations, relative to axis a, such as, for example,perpendicular and/or other angular orientations such as acute or obtuse,according to the requirements of a particular application. It iscontemplated that at least a portion of the body of osteograft 30 may besurface demineralized to promote chemical or cohesive bonding betweenthe body and plug(s) 62.

In some embodiments, osteograft 30 includes recesses 60 in side walls52, 54 extending transverse to axis a and plugs 62 disposed in suchrecesses 60. End walls 52, 54 may each include one or a plurality ofrecesses 60 therein. Side wall 52 includes a plurality of recesses 60that are each coaxial with recesses 60 in side wall 54. Thisconfiguration allows for a plug 62 comprising a material, such as, forexample, demineralized bone inserted into recesses 60 in side walls 52,54 to simultaneously distribute osteoconductive and/or osteoinductivematerial in the same amount and manner from side wall 52 as side wall 54such that the osteoconductive and/or osteoinductive material(s) may besubstantially uniformly distributed in passage 50. It is envisioned thatside wall 52 may include one or a plurality of recesses 60 that are notcoaxial with any recesses in side wall 54. This configuration allows fora plug 62 comprising a material, such as, for example, demineralizedbone inserted into recesses 60 in side walls 52, 54 to simultaneouslydistribute osteoconductive and/or osteoinductive material in differentamounts and directions from side wall 52 than side wall 54 such that theosteoconductive and/or osteoinductive material(s) may be substantiallyuniformly distributed in passage 50. It is further envisioned that sidewall 52 may include one or a plurality of recesses 60 that are coaxialwith recesses 60 in side wall 54 and one or a plurality of recesses 60that are not coaxial with recesses 60 in side wall 54. It iscontemplated that recesses 60 may be disposed in side walls 52, 54 atalternate orientations, relative to axis a, such as, for example,perpendicular and/or other angular orientations such as acute or obtuse,according to the requirements of a particular application.

In some embodiments, side walls 52, 54 each include a plurality ofrecesses 60 that are parallel to one another extending along an axisthat is perpendicular to axis a (FIG. 2A). In one embodiment, side walls52, 54 each include a plurality of recesses 60 that are parallel to oneanother extending along an axis that is parallel to axis a (FIG. 2B). Inone embodiment, side walls 52, 54 each include a plurality of recesses60 arranged in geometric pattern (FIG. 2C).

In some embodiments, osteograft 30 includes recesses 60 in end walls 56,58 extending parallel with axis a and plugs 62 disposed in such recesses60. End walls 56, 58 may each include one or a plurality of recesses 60therein. End wall 56 includes a plurality of recesses 60 that are eachcoaxial with recesses 60 in end wall 58. This configuration allows for aplug 62 comprising a material, such as, for example, demineralized boneinserted into recesses 60 in end walls 56, 58 to simultaneouslydistribute osteoconductive and/or osteoinductive material in the sameamount and manner from end wall 56 as end wall 58 such that theosteoconductive and/or osteoinductive material(s) may be substantiallyuniformly distributed in passage 50. It is envisioned that end wall 56may include one or a plurality of recesses 60 that are not coaxial withany recesses in end wall 58. This configuration allows for a plug 62comprising a material, such as, for example, demineralized bone insertedinto recesses 60 in end walls 56, 58 to simultaneously distributeosteoconductive and/or osteoinductive material in different amounts anddirections from end wall 56 than end wall 58 such that theosteoconductive and/or osteoinductive material(s) may be substantiallyuniformly distributed in passage 50. It is further envisioned that endwall 56 may include one or a plurality of recesses 60 that are coaxialwith recesses 60 in end wall 58 and one or a plurality of recesses 60that are not coaxial with recesses 60 in end wall 58. It is contemplatedthat recesses 60 may be disposed in end walls 56, 58 at alternateorientations, relative to axis a, such as, for example, transverse,perpendicular and/or other angular orientations such as acute or obtuse,according to the requirements of a particular application.

In some embodiments, end walls 56, 58 each include a single recess 60(FIG. 3A). The recesses 60 in end walls 56, 58 are coaxial with oneanother. It is envisioned that the single recess 60 in end walls 56, 58may be disposed equidistant from top and bottom surfaces 44, 46, may bedisposed closer to top surface 44 than bottom surface 46, or may bedisposed closer to bottom surface 46 than top surface, depending uponthe location in which osteoconductive and/or osteoinductive material.For example, if a particular application requires that moreosteoconductive and/or osteoinductive material be delivered adjacent topsurface 44 than bottom surface 46, recesses 60 in end walls 56, 58 maybe disposed closer to top surface 44 than bottom surface 46. It isfurther envisioned that the recesses 60 in end walls 56, 58 may beoffset from one another. In one embodiment, end walls 56, 58 eachinclude a plurality of recesses 60 that are parallel to one anotherextending along an axis extending perpendicular to top surface 44 (FIG.3B). In one embodiment, end walls 56, 58 each include a plurality ofrecesses 60 that are parallel to one another extending along an axisextending parallel to top surface 44 (FIG. 3C).

In some embodiments, plugs 62 comprise demineralized cancellous bone. Itis envisioned that plugs 62 may also comprise demineralized corticalbone, a combination of demineralized cancellous bone and demineralizedcortical bone, a combination of demineralized cancellous bone andnon-demineralized cortical bone, or a combination of non-demineralizedcancellous bone and demineralized cortical bone.

In some embodiments, plugs 62 comprise demineralized bone matrix. It isenvisioned that plugs 62 may comprise demineralized bone matrix fibersand demineralized bone matrix powder. It is further envisioned thatplugs 62 may comprise demineralized bone matrix fibers and demineralizedbone matrix powder in a ratio of 25:75 to about 75:25 fibers to chips.

In some embodiments, plugs 62 are surface demineralized to provide amore conducive surface for the demineralized bone to attach to via bothfriction and cohesive binding of collagen/protein compositions toosteograft 30. The healing process also exposes some of the inherentbone growth factors to further facilitate remodeling and new boneformation. The surface demineralization of plugs 62 provides an easierroute of entry for bone remodeling to occur in the osteograft 30 furtherfacilitating faster fusion.

Demineralized bone matrix (DBM) is demineralized bone withosteoinductive activity. DBM is prepared by acid extraction ofosteograft bone, resulting in loss of most of the mineralized componentbut retention of collagen and noncollagenous proteins, including growthfactors. DBM does not contain osteoprogenitor cells, but the efficacy ofa demineralized bone matrix may be influenced by a number of factors,including the sterilization process, the carrier, the total amount ofbone morphogenetic protein (BMP) present, and the ratios of thedifferent BMPs present. DBM includes demineralized pieces of corticalbone to expose the osteoinductive proteins contained in the matrix.These activated demineralized bone particles are usually added to asubstrate or carrier (e.g. glycerol or a polymer). DBM is mostly anosteoinductive product, but lacks enough induction to be used on its ownin challenging healing environments such as posterolateral spine fusion.

In some embodiments, the depth of surface demineralization in plugs 62may be between about 50 to about 5000 microns, or about 100 microns toabout 1000 microns or about 2000 microns. If desired, the outer surfacesof plugs 62 can be masked with an acid resistant coating or otherwisetreated to selectively demineralize unmasked portions of the outersurface of plugs 62 so that the surface demineralization is at discretepositions on plugs 62.

In some embodiments, plugs 60 are coated with demineralized bone, suchas, for example demineralized bone matrix. The demineralized bone isapplied to the surface of plug 62 and allowed to bind via air drying, oralternatively freeze dried, heat drying, or a mild chemical crosslinkingagent or adhesive can be used. The form of the DBM can be chips, shards,powders, fibers or a combination thereof, which are osteoinductive. Insome embodiments, each plug 62 can have both surface demineralizationand DBM chips, shards, powders, or a combination thereof disposed on itssurface.

In one embodiment, DBM powder can range in average particle size fromabout 0.0001 to about 1.2 cm and from about 0.002 to about 1 cm. Thebone powder can be obtained from cortical, cancellous and/orcorticocancellous allogenic or xenogenic bone tissue. In general,allogenic bone tissue is preferred as the source of the bone powder.

In some embodiments, the coating thickness of DBM powder and/or fiberson plugs 62 may be thin, for example, from about 5, 10, 15, 20, 25, 30,35, 40, 45 or 50 microns to thicker coatings 60, 65, 70, 75, 80, 85, 90,95, 100 microns. In some embodiments, the range of the coating rangesfrom about 5 microns to about 250 microns or 5 microns to about 200microns.

According to some embodiments of the disclosure, the demineralized bonematrix may comprise demineralized bone matrix fibers and/ordemineralized bone matrix chips. In some embodiments, the demineralizedbone matrix may comprise demineralized bone matrix fibers anddemineralized bone matrix chips in a 30:60 ratio. In differentembodiments of the disclosure, bone powder content can range from about5% to about 90% w/w, polymer content can range from about 5% to about90% w/w, and demineralized bone particles content comprises the reminderof the composition. Preferably, the demineralized bone particlescomprise from about 20% to about 40% w/w while the polymer and the bonepowder comprise each from about 20% to about 60% w/w of the composition.The bone graft materials of the present disclosure include thosestructures that have been modified in such a way that the originalchemical forces naturally present have been altered to attract and bindmolecules, including, without limitation, growth factors and/or cells,including cultured cells.

The demineralized bone that makes up plugs 62 may be further modifiedsuch that the original chemical forces naturally present have beenaltered to attract and bind growth factors, other proteins and cellsaffecting osteogenesis, osteoconduction and osteoinduction. For example,a demineralized bone material may be modified to provide an ionicgradient to produce a modified demineralized bone material, such thatimplanting plugs 62 including the modified demineralized bone materialresults in enhanced ingrowth of host bone.

In one embodiment an ionic force change agent may be applied to modifythe demineralized bone material. The demineralized allograft bonematerial may comprise, e.g., a demineralized bone matrix (DBM)comprising fibers, particles and any combination of thereof. Accordingto another embodiment, a bone graft structure may be used whichcomprises a composite bone, which includes a bone powder, a polymer anda demineralized bone.

The ionic force change agent may be applied to the entire demineralizedbone material or to selected portions/surfaces thereof. The ionic forcechange agent may be a binding agent, which modifies the demineralizedbone material to bind molecules, such as, for example, DBM, growthfactors, or cells, such as, for example, cultured cells, or acombination of molecules and cells. In the practice of the disclosurethe growth factors include but are not limited to BMP-2, rhBMP-2, BMP-4,rhBMP-4, BMP-6, rhBMP-6, BMP-7(OP-1), rhBMP-7, GDF-5, LIM mineralizationprotein, platelet derived growth factor (PDGF), transforming growthfactor-β (TGF-β), insulin-related growth factor-I (IGF-I),insulin-related growth factor-II (IGF-II), fibroblast growth factor(FGF), beta-2-microglobulin (BDGF II), and rhGDF-5. A person of ordinaryskill in the art will appreciate that the disclosure is not limited togrowth factors only. Other molecules can also be employed in thedisclosure. For example, tartrate-resistant acid phosphatase, which isnot a growth factor, may also be used in the disclosure.

An adhesive may be applied to the DBM powders and/or fibers to adherethe DBM powders and/or fibers to the outer surface of plugs 62 and/or toform plugs 62. The adhesive material may comprise polymers havinghydroxyl, carboxyl, and/or amine groups. In some embodiments, polymershaving hydroxyl groups include synthetic polysaccharides, such as forexample, cellulose derivatives, such as cellulose ethers (e.g.,hydroxypropylcellulose). In some embodiments, the synthetic polymershaving a carboxyl group, may comprise poly(acrylic acid),poly(methacrylic acid), poly(vinyl pyrrolidone acrylicacid-N-hydroxysuccinimide), and poly(vinyl pyrrolidone-acrylicacid-acrylic acid-N-hydroxysuccinimide) terpolymer. For example,poly(acrylic acid) with a molecular weight greater than 250,000 or500,000 may exhibit particularly good adhesive performance. In someembodiments, the adhesive can be a polymer having a molecular weight ofabout 2,000 to about 5,000, or about 10,000 to about 20,000 or about30,000 to about 40,000.

In some embodiments, the adhesive can comprise imido ester,p-nitrophenyl carbonate, N-hydroxysuccinimide ester, epoxide,isocyanate, acrylate, vinyl sulfone, orthopyridyl-disulfide, maleimide,aldehyde, iodoacetamide or a combination thereof. In some embodiments,the adhesive material can comprise at least one of fibrin, acyanoacrylate (e.g., N-butyl-2-cyanoacrylate, 2-octyl-cyanoacrylate,etc.), a collagen-based component, a glutaraldehyde glue, a hydrogel,gelatin, an albumin solder, and/or a chitosan adhesives. In someembodiments, the hydrogel comprises acetoacetate esters crosslinked withamino groups or polyethers as mentioned in U.S. Pat. No. 4,708,821. Insome embodiments, the adhesive material can comprise poly(hydroxylic)compounds derivatized with acetoacetate groups and/or polyaminocompounds derivatized with acetoacetamide groups by themselves or thecombination of these compounds crosslinked with an amino-functionalcrosslinking compounds.

The adhesive can be a solvent based adhesive, a polymer dispersionadhesive, a contact adhesive, a pressure sensitive adhesive, a reactiveadhesive, such as for example multi-part adhesives, one part adhesives,heat curing adhesives, moisture curing adhesives, or a combinationthereof or the like. The adhesive can be natural or synthetic or acombination thereof.

Contact adhesives are used in strong bonds with high shear-resistance.Pressure sensitive adhesives form a bond by the application of lightpressure to bind the adhesive with the target tissue site, cannulaand/or expandable member. In some embodiments, to have the device adhereto the target tissue site, pressure is applied in a directionsubstantially perpendicular to a surgical incision.

Multi-component adhesives harden by mixing two or more components, whichchemically react. This reaction causes polymers to cross-link intoacrylics, urethanes, and/or epoxies. There are several commercialcombinations of multi-component adhesives in use in industry. Some ofthese combinations are: polyester resin-polyurethane resin;polyols-polyurethane resin, acrylic polymers-polyurethane resins or thelike. The multi-component resins can be either solvent-based orsolvent-less. In some embodiments, the solvents present in the adhesivesare a medium for the polyester or the polyurethane resin. Then thesolvent is dried during the curing process.

In some embodiments, the adhesive can be a one-part adhesive. One-partadhesives harden via a chemical reaction with an external energy source,such as radiation, heat, and moisture. Ultraviolet (UV) light curingadhesives, also known as light curing materials (LCM), have becomepopular within the manufacturing sector due to their rapid curing timeand strong bond strength. Light curing adhesives are generally acrylicbased. The adhesive can be a heat-curing adhesive, where when heat isapplied (e.g., body heat), the components react and cross-link. Thistype of adhesive includes epoxies, urethanes, and/or polyimides. Theadhesive can be a moisture curing adhesive that cures when it reactswith moisture present (e.g., bodily fluid) on the substrate surface orin the air. This type of adhesive includes cyanoacrylates or urethanes.The adhesive can have natural components, such as for example, vegetablematter, starch (dextrin), natural resins or from animals e.g. casein oranimal glue. The adhesive can have synthetic components based onelastomers, thermoplastics, emulsions, and/or thermosets includingepoxy, polyurethane, cyanoacrylate, or acrylic polymers.

In some embodiments, the body of osteograft 30 comprises an allograftand the body of osteograft 30 and plugs 62 each comprise bone materialobtained from the same donor. In some embodiments, the body ofosteograft 30 comprises an allograft and plugs 62 each comprise bonematerial obtained from the patient. In some embodiments, the body ofosteograft 30 comprises an autograft and the body of osteograft 30 andplugs 62 each comprise bone material obtained from the patient. Theseconfigurations allow new bone to form quickly because host bone does nothave to go through the process of osteoclastic resorption first,resulting in faster stabilization of osteograft 30 and fusion.

In some embodiments, recesses 60 have a circular cross sectionalconfiguration and plugs 62 have a polygonal cross sectionalconfiguration, such as, for example, square (FIGS. 4A and 4B). Plugs 62comprise demineralized cancellous bone and the body of osteograft 30comprises cortical bone, as discussed above. The width of plugs 62 issubstantially equivalent to the diameter of recesses 60 such that plugs62 are press fit into recesses 60 (FIG. 5). It is envisioned that thewidth of plugs 62 may also be greater than to the diameter of recesses60 to improve fixation of plugs 62 within recesses 60. It is furtherenvisioned that plugs 62 may also have a width that is less than thediameter of recesses 60 to facilitate insertion of plugs 62 intorecesses 60. It is contemplated that plugs 62 may have a height that issubstantially equivalent to a depth of recesses 60 to ensure that plugs62 are completely disposed within recesses 60. It is furthercontemplated that plugs 62 may have a height that is greater than adepth of recesses 60 to increase the amount of osteoinductive and/orosteoinductive material disposed in recesses 60.

In some embodiments, plugs 62 are sufficiently demineralized allowingplugs 62 to deform such that plugs 62 can be inserted into recesses 60having a maximum width that is less than a maximum width of plugs 62.This configuration allows pressure to be applied to plugs 62, such as,for example, by squeezing plugs 62 as plugs 62 are inserted intorecesses 60. Once pressure is released, plugs 62 expand within recesses60 to maintain plugs 62 in recesses 60. In some embodiments, plugs 62comprise from about 1% to about 30% or from about 5% to about 25% byweight of demineralized bone material.

In some embodiments, recesses 60 have a circular cross sectionalconfiguration and plugs 62 have a circular cross sectional configuration(FIGS. 6A and 6B). Plugs 62 comprise demineralized cancellous bone andthe body of osteograft 30 comprises cortical bone, as discussed above.The diameter of plugs 62 is greater than the diameter of recesses 60such that plugs 62 are press fit into recesses 60. It is envisioned thatthe width of plugs 62 may also be substantially equivalent to thediameter of recesses 60 to facilitate insertion of plugs 62 intorecesses 60.

In some embodiments, plugs 62 comprise strips of demineralized bone(FIGS. 7A and 7B). Plugs 62 comprise demineralized cancellous bone andthe body of osteograft 30 comprises cortical bone, as discussed above.Recesses 60 have a volume sufficient for disposal of a plurality ofplugs 62, when plugs 62 are in the form of strips. It is envisioned thatplugs 62, when in the form of strips, are sufficiently flexible suchthat a plurality of plugs 62 can packed into each recess 60. It isfurther envisioned that plugs, 62, when in the form of strips, have alength that is greater than a width and/or depth of recesses 60, but canbe squeezed to decrease the length thereof such that the length of plugs62 is less than the width and/or the depth of recesses 60. Plugs 62would then expand following insertion into recesses 60 to maintain plugs62 within recesses 60.

In some embodiments, osteograft 30 includes a plurality of spaced apartrecesses 60 in top surface 44 (FIG. 8A) and a plurality of spaced apartrecesses 60 in bottom surface 46 (FIG. 8B). Osteograft 30 includes atleast one recess 60 in corners of top and bottom surfaces 44, 46 betweenside wall 36 and end wall 40 and between side wall 38 and end wall 42.Osteograft 30 also includes at least one recess 60 that is parallel withthe recess(es) 60 in corners of top and bottom surfaces 44, 46 betweenside wall 36 and end wall 40 along axis a and at least one recess 60that is parallel with the recess(es) 60 in corners of top and bottomsurfaces 44, 46 between side wall 38 and end wall 42 along axis a suchthat recesses 60 in top surface 44 are coaxial with recesses 60 inbottom surface 46 (FIGS. 8C and 8D). This configuration allows for aplug 62 comprising a material, such as, for example, demineralized boneinserted into recesses 60 to simultaneously distribute osteoconductiveand/or osteoinductive material in the same amount and manner from topsurface 44 as bottom surface 46.

In some embodiments, osteograft 30 includes a plurality of spaced apartrecesses 60 in top surface 44 (FIG. 9A) and a plurality of spaced apartrecesses 60 in bottom surface 46 (FIG. 9B). Osteograft 30 includes atleast one recess 60 in corners of top and bottom surfaces 44, 46 betweenside wall 36 and end wall 42 and between side wall 38 and end wall 40.Osteograft 30 also includes at least one recess 60 that is parallel withthe recess(es) 60 in corners of top and bottom surfaces 44, 46 betweenside wall 36 and end wall 42 along axis a and at least one recess 60that is parallel with the recess(es) 60 in corners of top and bottomsurfaces 44, 46 between side wall 38 and end wall 40 along axis a suchthat recesses 60 in top surface 44 are coaxial with recesses 60 inbottom surface 46 (FIGS. 9C and 9D). This configuration allows for aplug 62 comprising a material, such as, for example, demineralized boneinserted into recesses 60 to simultaneously distribute osteoconductiveand/or osteoinductive material in the same amount and manner from topsurface 44 as bottom surface 46.

In some embodiments, osteograft 30 includes a plurality of spaced apartrecesses 60 in top surface 44 (FIG. 10A) and a plurality of spaced apartrecesses 60 in bottom surface 46 (FIG. 10B). Osteograft 30 includes atleast one recess 60 in top and bottom surfaces 44, 46 positioned closerto end 32 than end 34. Osteograft 30 does not include any recesses 60 intop and bottom surfaces 44, 46 adjacent end 34. It is envisioned thatrecesses 60 in top and bottom surfaces 44, 46 may alternatively bepositioned closer to end 34 than end 32. It is further envisioned thatthe that recesses 60 in top surface 44 may be coaxial with recesses 60in bottom surface 46 (FIGS. 10C and 10D). This configuration allows fora plug 62 comprising a material, such as, for example, demineralizedbone inserted into recesses 60 to distribute osteoconductive and/orosteoinductive material from top surface 44 and bottom surface 46 to aparticular location, such as, for example, a lateral side of anintervertebral space, without directly distributing osteoconductiveand/or osteoinductive material to other adjacent locations, such as, forexample, an opposite lateral side of the intervertebral space. It isenvisioned that this configuration also avoids osteograft subsidence.

In some embodiments, osteograft 30 includes a plurality of spaced apartrecesses 60 in top surface 44 (FIG. 11A) and a plurality of spaced apartrecesses 60 in bottom surface 46 (FIG. 11B). Osteograft 30 includes atleast one recess 60 in top surface 44 positioned closer to end 32 thanend 34 and at least one recess 60 in bottom surface 46 positioned closerto end 34 than end 32. Osteograft 30 does not include any recesses 60 intop surfaces 44 adjacent end 34 or any recesses 60 in bottom surfaceadjacent end 32 such that recesses 60 in top surface 44 are not coaxialwith recesses 60 in bottom surface 46 (FIGS. 11C and 11D). It isenvisioned that recesses 60 in top and bottom surfaces 44, 46 mayalternatively be positioned such that recesses 60 in top surface 44 arepositioned closer to end 34 than end 32 and recesses 60 in bottomsurface 46 positioned closer to end 32 than end 34. This configurationallows for a plug 62 comprising a material, such as, for example,demineralized bone inserted into recesses 60 to distributeosteoconductive and/or osteoinductive material from top surface 44 inone direction and a plug 62 to distribute osteoconductive and/orosteoinductive material from bottom surface 46 in an opposite direction.

In some embodiments, recesses 60 comprise about less than 50% of theentire graft 10. In some embodiments, recesses 60 comprise about lessthan 33% of the entire graft. In some embodiments, recesses 60 compriseabout less than 66% of the entire graft. In some embodiments, recesses60 comprise about less than 75% of the entire graft.

It is envisioned that top and bottom surfaces 44, 46 of osteograft 30may include any combination of the configurations of plugs 62 andrecesses 60 shown in FIGS. 1A-11D. For example, top surface 44 mayinclude at least one recess 60 in corners of top surface 44 between sidewall 36 and end wall 40, between side wall 36 and end wall 42, betweenside wall 38 and end wall 40 and between side wall 38 and end wall 42(FIG. 12A) and bottom surface 46 may include at least one recess 60 incorners of bottom surface 46 between side wall 36 and end wall 40 andbetween side wall 38 and end wall 42 (FIG. 12B). Bottom surface 46 alsoincludes at least one recess 60 that is parallel with the recess(es) 60in corner of bottom surface 46 between side wall 36 and end wall 40along axis a and at least one recess 60 that is parallel with therecess(es) 60 in corner of bottom surface 46 between side wall 38 andend wall 42 along axis a (FIG. 12 B) such that at least one recess 60 intop surface 44 is aligned with at least one recess 60 in bottom surface46 and at least one recess 60 in top surface 44 is offset from at leastone recess 60 in bottom surface 46 (FIGS. 12C and 12D). This allows amedical practitioner to vary the number of recesses 60 in osteograft 30as well as determine suitable locations for such recesses 60 so thatplugs 62 can be disposed therein to selectively deliver osteoinductiveand/or osteoconductive material directly to specific areas of apatient's anatomy, depending upon the requirements of a particularapplication, without delivering osteoinductive and/or osteoconductivematerial directly to other areas.

In some embodiments, the body of osteograft 30 has a substantially ovalcross sectional configuration (FIGS. 13A-13D). Osteograft 30 includes aplurality of recesses 60 that are distributed uniformly andcircumferentially on top surface 44 (FIG. 13A) and bottom surface 46(FIG. 13B) such that recesses 60 in top surface 44 are coaxial withrecesses 60 in bottom surface 46 (FIGS. 13C and 13D). It is envisionedthat top surface 44 may include one or a plurality of recesses 60 thatare each coaxial with an equal number of recesses 60 in bottom surface46. This configuration allows for a plug 62 comprising a material, suchas, for example, demineralized bone inserted into recesses 60 tosimultaneously distribute osteoconductive and/or osteoinductive materialin the same amount and manner from top surface 44 as bottom surface 46.

In some embodiments, osteograft 30 is configured to increase the surfacearea contact of osteograft 30 with the host bone, which will result infaster fusion and incorporation of the osteograft 30 into host bone andultimately a stronger fusion mass. In some embodiments, the allograftbone used to form osteograft 30 is surface demineralized to increase itsosteoinductivity and fusion with the host bone.

In some embodiments, osteograft 30 comprises a plurality of poresextending into an outer surface thereof. In some embodiments, the poresin osteograft 30 are interconnected. In some embodiments, at least 10%of the pores are between about 10 micrometers and about 500 micrometersat their widest points. In some embodiments, at least 20% of the poresare between about 50 micrometers and about 150 micrometers at theirwidest points. In some embodiments, at least 30% of the pores arebetween about 30 micrometers and about 70 micrometers at their widestpoints. In some embodiments, at least 50% of the pores are between about10 micrometers and about 500 micrometers at their widest points. In someembodiments, at least 90% of the pores are between about 50 micrometersand about 150 micrometers at their widest points. In some embodiments,at least 95% of the pores are between about 100 micrometers and about250 micrometers at their widest points. In some embodiments, 100% of thepores are between about 10 micrometers and about 300 micrometers attheir widest points.

In some embodiments, osteograft 30 has a porosity of at least about 30%,at least about 50%, at least about 60%, at least about 70%, at leastabout 90%. The pores may support ingrowth of cells, formation orremodeling of bone, cartilage and/or vascular tissue.

In some embodiments, osteograft 30 may be seeded with harvested bonecells and/or bone tissue, such as for example, cortical bone, autogenousbone, allogenic bones and/or xenogenic bone. In some embodiments,osteograft 30 may be seeded with harvested cartilage cells and/orcartilage tissue (e.g., autogenous, allogenic, and/or xenogeniccartilage tissue). For example, before insertion into the target tissuesite, osteograft 30 can be wetted with the graft bone tissue/cells,usually with bone tissue/cells aspirated from the patient, at a ratio ofabout 3:1, 2:1, 1:1, 1:3 or 1:2 by volume. The bone tissue/cells arepermitted to soak into the allograft provided, and the allograft may bekneaded by hand, thereby obtaining a pliable consistency that maysubsequently be packed into the osteochondral defect.

In some embodiments, a therapeutic agent may be disposed on or inosteograft 30 by hand, electrospraying, ionization spraying orimpregnating, vibratory dispersion (including sonication), nozzlespraying, compressed-air-assisted spraying, brushing and/or pouring. Forexample, a growth factor such as rhBMP-2 may be disposed on or inosteograft 30.

In some embodiments, recesses 60 can be drilled into osteograft 30 andthen plug 62 implanted into the recess 60. In some embodiments, plugs 60stay in recesses 60 better if plugs 62 are cored from freeze drieddemineralized bone and then press-fit rather than coring undemineralizedor fully mineralized bone plugs or inserts, demineralizing them,press-fitting into recesses 60 and freeze drying the complete osteograft30, including plugs 62. Freeze drying causes plugs 62 to shrink and fallout of recesses 60. In some embodiments, plugs 62 are flush with anouter surface of osteograft 30 when disposed in recesses 60. In someembodiments, plugs protrude from osteograft 30 when disposed in recesses60. In some embodiments, plugs are not flush with osteograft 30 whendisposed in recesses 60, but are below its surface.

Osteograft 30 may also include mechanisms or features for reducingand/or preventing slippage or migration of the device during insertion.For example, one or more surfaces of osteograft 30 may includeprojections such as ridges or teeth (not shown) for increasing thefriction between osteograft 30 and the adjacent contacting surfaces ofthe bone so to prevent movement of osteograft 30 after introduction to adesired location.

Growth Factors

In some embodiments, a growth factor and/or therapeutic agent may bedisposed on or in osteograft 30 by hand, electrospraying, ionizationspraying or impregnating, vibratory dispersion (including sonication),nozzle spraying, compressed-air-assisted spraying, brushing and/orpouring. For example, a growth factor such as rhBMP-2 may be disposed onor in osteograft 30 by the surgeon before osteograft 30 is administeredor it may be available from the manufacturer beforehand.

Osteograft 30 may comprise at least one growth factor. These growthfactors include osteoinductive agents (e.g., agents that cause new bonegrowth in an area where there was none) and/or osteoconductive agents(e.g., agents that cause in growth of cells into and/or through theallograft). Osteoinductive agents can be polypeptides or polynucleotidescompositions. Polynucleotide compositions of the osteoinductive agentsinclude, but are not limited to, isolated Bone Morphogenetic Protein(BMP), Vascular Endothelial Growth Factor (VEGF), Connective TissueGrowth Factor (CTGF), Osteoprotegerin, Growth Differentiation Factors(GDFs), Cartilage Derived Morphogenic Proteins (CDMPs), LimMineralization Proteins (LMPs), Platelet derived growth factor, (PDGF orrhPDGF), Insulin-like growth factor (IGF) or Transforming Growth Factorbeta (TGF-beta) polynucleotides. Polynucleotide compositions of theosteoinductive agents include, but are not limited to, gene therapyvectors harboring polynucleotides encoding the osteoinductivepolypeptide of interest. Gene therapy methods often utilize apolynucleotide, which codes for the osteoinductive polypeptideoperatively linked or associated to a promoter or any other geneticelements necessary for the expression of the osteoinductive polypeptideby the target tissue. Such gene therapy and delivery techniques areknown in the art, (See, for example, International Publication No.WO90/11092, the disclosure of which is herein incorporated by referencein its entirety). Suitable gene therapy vectors include, but are notlimited to, gene therapy vectors that do not integrate into the hostgenome. Alternatively, suitable gene therapy vectors include, but arenot limited to, gene therapy vectors that integrate into the hostgenome.

In some embodiments, the polynucleotide is delivered in plasmidformulations. Plasmid DNA or RNA formulations refer to polynucleotidesequences encoding osteoinductive polypeptides that are free from anydelivery vehicle that acts to assist, promote or facilitate entry intothe cell, including viral sequences, viral particles, liposomeformulations, lipofectin, precipitating agents or the like. Optionally,gene therapy compositions can be delivered in liposome formulations andlipofectin formulations, which can be prepared by methods well known tothose skilled in the art. General methods are described, for example, inU.S. Pat. Nos. 5,593,972, 5,589,466, and 5,580,859, the disclosures ofwhich are herein incorporated by reference in their entireties.

Gene therapy vectors further comprise suitable adenoviral vectorsincluding, but not limited to for example, those described in U.S. Pat.No. 5,652,224, which is herein incorporated by reference.

Polypeptide compositions of the isolated osteoinductive agents include,but are not limited to, isolated Bone Morphogenetic Protein (BMP),Vascular Endothelial Growth Factor (VEGF), Connective Tissue GrowthFactor (CTGF), Osteoprotegerin, Growth Differentiation Factors (GDFs),Cartilage Derived Morphogenic Proteins (CDMPs), Lim MineralizationProteins (LMPs), Platelet derived growth factor, (PDGF or rhPDGF),Insulin-like growth factor (IGF) or Transforming Growth Factor beta(TGF-beta707) polypeptides. Polypeptide compositions of theosteoinductive agents include, but are not limited to, full lengthproteins, fragments or variants thereof.

Variants of the isolated osteoinductive agents include, but are notlimited to, polypeptide variants that are designed to increase theduration of activity of the osteoinductive agent in vivo. Preferredembodiments of variant osteoinductive agents include, but are notlimited to, full length proteins or fragments thereof that areconjugated to polyethylene glycol (PEG) moieties to increase theirhalf-life in vivo (also known as pegylation). Methods of pegylatingpolypeptides are well known in the art (See, e.g., U.S. Pat. No.6,552,170 and European Pat. No. 0,401,384 as examples of methods ofgenerating pegylated polypeptides). In some embodiments, the isolatedosteoinductive agent(s) are provided as fusion proteins. In oneembodiment, the osteoinductive agent(s) are available as fusion proteinswith the Fc portion of human IgG. In another embodiment, theosteoinductive agent(s) are available as hetero- or homodimers ormultimers. Examples of some fusion proteins include, but are not limitedto, ligand fusions between mature osteoinductive polypeptides and the Fcportion of human Immunoglobulin G (IgG). Methods of making fusionproteins and constructs encoding the same are well known in the art.

Isolated osteoinductive agents that are included within a carrier aretypically sterile. In a non-limiting method, sterility is readilyaccomplished for example by filtration through sterile filtrationmembranes (e.g., 0.2 micron membranes or filters). In one embodiment,the isolated osteoinductive agents include one or more members of thefamily of Bone Morphogenetic Proteins (“BMPs”). BMPs are a class ofproteins thought to have osteoinductive or growth-promoting activitieson endogenous bone tissue, or function as pro-collagen precursors. Knownmembers of the BMP family include, but are not limited to, BMP-1, BMP-2,BMP-3, BMP-4, BMP-5, BMP-6, BMP-7, BMP-8, BMP-9, BMP-10, BMP-11, BMP-12,BMP-13, BMP-15, BMP-16, BMP-17, BMP-18 as well as polynucleotides orpolypeptides thereof, as well as mature polypeptides or polynucleotidesencoding the same.

BMPs utilized as osteoinductive agents comprise one or more of BMP-1;BMP-2; BMP-3; BMP-4; BMP-5; BMP-6; BMP-7; BMP-8; BMP-9; BMP-10; BMP-11;BMP-12; BMP-13; BMP-15; BMP-16; BMP-17; or BMP-18; as well as anycombination of one or more of these BMPs, including full length BMPs orfragments thereof, or combinations thereof, either as polypeptides orpolynucleotides encoding the polypeptide fragments of all of the recitedBMPs. The isolated BMP osteoinductive agents may be administered aspolynucleotides, polypeptides, full length protein or combinationsthereof.

In another embodiment, isolated osteoinductive agents includeosteoclastogenesis inhibitors to inhibit bone resorption of the bonetissue surrounding the site of implantation by osteoclasts. Osteoclastand osteoclastogenesis inhibitors include, but are not limited to,osteoprotegerin polynucleotides or polypeptides, as well as matureosteoprotegerin proteins, polypeptides or polynucleotides encoding thesame. Osteoprotegerin is a member of the TNF-receptor superfamily and isan osteoblast-secreted decoy receptor that functions as a negativeregulator of bone resorption. This protein specifically binds to itsligand, osteoprotegerin ligand (TNFSF11/OPGL), both of which are keyextracellular regulators of osteoclast development.

Osteoclastogenesis inhibitors further include, but are not limited to,chemical compounds such as bisphosphonate, 5-lipoxygenase inhibitorssuch as those described in U.S. Pat. Nos. 5,534,524 and 6,455,541 (thecontents of which are herein incorporated by reference in theirentireties), heterocyclic compounds such as those described in U.S. Pat.No. 5,658,935 (herein incorporated by reference in its entirety),2,4-dioxoimidazolidine and imidazolidine derivative compounds such asthose described in U.S. Pat. Nos. 5,397,796 and 5,554,594 (the contentsof which are herein incorporated by reference in their entireties),sulfonamide derivatives such as those described in U.S. Pat. No.6,313,119 (herein incorporated by reference in its entirety), oracylguanidine compounds such as those described in U.S. Pat. No.6,492,356 (herein incorporated by reference in its entirety).

In another embodiment, isolated osteoinductive agents include one ormore members of the family of Connective Tissue Growth Factors(“CTGFs”). CTGFs are a class of proteins thought to havegrowth-promoting activities on connective tissues. Known members of theCTGF family include, but are not limited to, CTGF-1, CTGF-2, CTGF-4polynucleotides or polypeptides thereof, as well as mature proteins,polypeptides or polynucleotides encoding the same.

In another embodiment, isolated osteoinductive agents include one ormore members of the family of Vascular Endothelial Growth Factors(“VEGFs”). VEGFs are a class of proteins thought to havegrowth-promoting activities on vascular tissues. Known members of theVEGF family include, but are not limited to, VEGF-A, VEGF-B, VEGF-C,VEGF-D, VEGF-E or polynucleotides or polypeptides thereof, as well asmature VEGF-A, proteins, polypeptides or polynucleotides encoding thesame.

In another embodiment, isolated osteoinductive agents include one ormore members of the family of Transforming Growth Factor-beta genes(“TGFbetas”). TGF-betas are a class of proteins thought to havegrowth-promoting activities on a range of tissues, including connectivetissues. Known members of the TGF-beta family include, but are notlimited to, TGF-beta-1, TGF-beta-2, TGF-beta-3, polynucleotides orpolypeptides thereof, as well as mature protein, polypeptides orpolynucleotides encoding the same.

In another embodiment, isolated osteoinductive agents include one ormore Growth Differentiation Factors (“GDFs”). Known GDFs include, butare not limited to, GDF-1, GDF-2, GDF-3, GDF-7, GDF-10, GDF-11, andGDF-15. For example, GDFs useful as isolated osteoinductive agentsinclude, but are not limited to, the following GDFs: GDF-1polynucleotides or polypeptides corresponding to GenBank AccessionNumbers M62302, AAA58501, and AAB94786, as well as mature GDF-1polypeptides or polynucleotides encoding the same. GDF-2 polynucleotidesor polypeptides corresponding to GenBank Accession Numbers BC069643,BC074921, Q9UK05, AAH69643, or AAH74921, as well as mature GDF-2polypeptides or polynucleotides encoding the same. GDF-3 polynucleotidesor polypeptides corresponding to GenBank Accession Numbers AF263538,BC030959, AAF91389, AAQ89234, or Q9NR23, as well as mature GDF-3polypeptides or polynucleotides encoding the same. GDF-7 polynucleotidesor polypeptides corresponding to GenBank Accession Numbers AB158468,AF522369, AAP97720, or Q7Z4P5, as well as mature GDF-7 polypeptides orpolynucleotides encoding the same. GDF-10 polynucleotides orpolypeptides corresponding to GenBank Accession Numbers BC028237 orAAH28237, as well as mature GDF-10 polypeptides or polynucleotidesencoding the same.

GDF-11 polynucleotides or polypeptides corresponding to GenBankAccession Numbers AF100907, NP_(—005802) or 095390, as well as matureGDF-11 polypeptides or polynucleotides encoding the same. GDF-15polynucleotides or polypeptides corresponding to GenBank AccessionNumbers BC008962, BC000529, AAH00529, or NP004855, as well as matureGDF-15 polypeptides or polynucleotides encoding the same.

In another embodiment, isolated osteoinductive agents include CartilageDerived Morphogenic Protein (CDMP) and Lim Mineralization Protein (LMP)polynucleotides or polypeptides. Known CDMPs and LMPs include, but arenot limited to, CDMP-1, CDMP-2, LMP-1, LMP-2, or LMP-3.

CDMPs and LMPs useful as isolated osteoinductive agents include, but arenot limited to, the following CDMPs and LMPs: CDMP-1 polynucleotides andpolypeptides corresponding to GenBank Accession Numbers NM_(—000557),U13660, NP_(—000548) or P43026, as well as mature CDMP-1 polypeptides orpolynucleotides encoding the same. CDMP-2 polypeptides corresponding toGenBank Accession Numbers or P55106, as well as mature CDMP-2polypeptides. LMP-1 polynucleotides or polypeptides corresponding toGenBank Accession Numbers AF345904 or AAK30567, as well as mature LMP-1polypeptides or polynucleotides encoding the same. LMP-2 polynucleotidesor polypeptides corresponding to GenBank Accession Numbers AF345905 orAAK30568, as well as mature LMP-2 polypeptides or polynucleotidesencoding the same. LMP-3 polynucleotides or polypeptides correspondingto GenBank Accession Numbers AF345906 or AAK30569, as well as matureLMP-3 polypeptides or polynucleotides encoding the same.

In another embodiment, isolated osteoinductive agents include one ormore members of any one of the families of Bone Morphogenetic Proteins(BMPs), Connective Tissue Growth Factors (CTGFs), Vascular EndothelialGrowth Factors (VEGFs), Osteoprotegerin or any of the otherosteoclastogenesis inhibitors, Growth Differentiation Factors (GDFs),Cartilage Derived Morphogenic Proteins (CDMPs), Lim MineralizationProteins (LMPs), or Transforming Growth Factor-betas (TGF-betas), TP508(an angiogenic tissue repair peptide), as well as mixtures orcombinations thereof.

In another embodiment, the one or more isolated osteoinductive agentsuseful in the bioactive formulation are selected from the groupconsisting of BMP-1, BMP-2, BMP-3, BMP-4, BMP-5, BMP-6, BMP-7, BMP-8,BMP-9, BMP-10, BMP-11, BMP-12, BMP-13, BMP-15, BMP-16, BMP-17, BMP-18,or any combination thereof; CTGF-1, CTGF-2, CGTF-3, CTGF-4, or anycombination thereof; VEGF-A, VEGF-B, VEGF-C, VEGF-D, VEGF-E, or anycombination thereof; GDF-1, GDF-2, GDF-3, GDF-7, GDF-10, GDF-11, GDF-15,or any combination thereof; CDMP-1, CDMP-2, LMP-1, LMP-2, LMP-3, and orcombination thereof; Osteoprotegerin; TGF-beta-1, TGF-beta-2,TGF-beta-3, or any combination thereof; or any combination of one ormore members of these groups.

The concentrations of growth factor can be varied based on the desiredlength or degree of osteogenic effects desired. Similarly, one of skillin the art will understand that the duration of sustained release of thegrowth factor can be modified by the manipulation of the compositionscomprising the sustained release formulation, such as for example,modifying the percent of allograft found within a sustained releaseformulation, microencapsulation of the formulation within polymers,including polymers having varying degradation times and characteristics,and layering the formulation in varying thicknesses in one or moredegradable polymers. These sustained release formulations can thereforebe designed to provide customized time release of growth factors thatsimulate the natural healing process.

In some embodiments, a statin may be used as the growth factor. Statinsinclude, but is not limited to, atorvastatin, simvastatin, pravastatin,cerivastatin, mevastatin (see U.S. Pat. No. 3,883,140, the entiredisclosure is herein incorporated by reference), velostatin (also calledsynvinolin; see U.S. Pat. Nos. 4,448,784 and 4,450,171 these entiredisclosures are herein incorporated by reference), fluvastatin,lovastatin, rosuvastatin and fluindostatin (Sandoz XU-62-320),dalvastain (EP Appln. Publn. No. 738510 A2, the entire disclosure isherein incorporated by reference), eptastatin, pitavastatin, orpharmaceutically acceptable salts thereof or a combination thereof. Invarious embodiments, the statin may comprise mixtures of (+)R and (−)-Senantiomers of the statin. In various embodiments, the statin maycomprise a 1:1 racemic mixture of the statin.

The growth factor may contain inactive materials such as bufferingagents and pH adjusting agents such as potassium bicarbonate, potassiumcarbonate, potassium hydroxide, sodium acetate, sodium borate, sodiumbicarbonate, sodium carbonate, sodium hydroxide or sodium phosphate;degradation/release modifiers; drug release adjusting agents;emulsifiers; preservatives such as benzalkonium chloride, chlorobutanol,phenylmercuric acetate and phenylmercuric nitrate, sodium bisulfate,sodium bisulfate, sodium thiosulfate, thimerosal, methylparaben,polyvinyl alcohol and phenylethyl alcohol; solubility adjusting agents;stabilizers; and/or cohesion modifiers. In some embodiments, the growthfactor may comprise sterile and/or preservative free material.

These above inactive ingredients may have multi-functional purposesincluding the carrying, stabilizing and controlling the release of thegrowth factor and/or other therapeutic agent(s). The sustained releaseprocess, for example, may be by a solution-diffusion mechanism or it maybe governed by an erosion-sustained process.

The amount of growth factor, e.g., bone morphogenic protein may besufficient to cause bone and/or cartilage growth. In some embodiments,the growth factor is rhBMP-2 and is contained in one or more carriers inan amount of from 0.05 to 2 mg per cubic centimeter of the biodegradablecarrier. In some embodiments, the amount of rhBMP-2 morphogenic proteinis from 2.0 to 2.5 mg per cubic centimeter (cc) of the biodegradablecarrier.

In some embodiments, the growth factor is supplied in an aqueousbuffered solution. Exemplary aqueous buffered solutions include, but arenot limited to, TE, HEPES(2-[4-(2-hydroxyethyl)-1-piperazinyl]ethanesulfonic acid), MES(2-morpholinoethanesulfonic acid), sodium acetate buffer, sodium citratebuffer, sodium phosphate buffer, a Tris buffer (e.g., Tris-HCL),phosphate buffered saline (PBS), sodium phosphate, potassium phosphate,sodium chloride, potassium chloride, glycerol, calcium chloride or acombination thereof. In various embodiments, the buffer concentrationcan be from about 1 mM to 100 mM.

In some embodiments, the BMP-2 is provided in a vehicle (including abuffer) containing sucrose, glycine, L-glutamic acid, sodium chloride,and/or polysorbate 80.

Additional Therapeutic Agents

The growth factors of the present application may be disposed on or inosteograft 30 with other therapeutic agents. For example, the growthfactor may be disposed on or in osteograft 30 by electrospraying,ionization spraying or impregnating, vibratory dispersion (includingsonication), nozzle spraying, compressed-air-assisted spraying, brushingand/or pouring.

Exemplary therapeutic agents include but are not limited to IL-1inhibitors, such Kineret® (anakinra), which is a recombinant,non-glycosylated form of the human inerleukin-1 receptor antagonist(IL-1Ra), or AMG 108, which is a monoclonal antibody that blocks theaction of IL-1. Therapeutic agents also include excitatory amino acidssuch as glutamate and aspartate, antagonists or inhibitors of glutamatebinding to NMDA receptors, AMPA receptors, and/or kainate receptors.Interleukin-1 receptor antagonists, thalidomide (a TNF-α releaseinhibitor), thalidomide analogues (which reduce TNF-α production bymacrophages), quinapril (an inhibitor of angiotensin II, whichupregulates TNF-α), interferons such as IL-11 (which modulate TNF-αreceptor expression), and aurin-tricarboxylic acid (which inhibitsTNF-α), may also be useful as therapeutic agents for reducinginflammation. It is further contemplated that where desirable apegylated form of the above may be used. Examples of still othertherapeutic agents include NF kappa B inhibitors such as antioxidants,such as dilhiocarbamate, and other compounds, such as, for example,sulfasalazine.

Examples of therapeutic agents suitable for use also include, but arenot limited to an anti-inflammatory agent, analgesic agent, orosteoinductive growth factor or a combination thereof. Anti-inflammatoryagents include, but are not limited to, apazone, celecoxib, diclofenac,diflunisal, enolic acids (piroxicam, meloxicam), etodolac, fenamates(mefenamic acid, meclofenamic acid), gold, ibuprofen, indomethacin,ketoprofen, ketorolac, nabumetone, naproxen, nimesulide, salicylates,sulfasalazine [2-hydroxy-5-[-4-[C2-pyridinylamino)sulfonyl]azo]benzoicacid, sulindac, tepoxalin, and tolmetin; as well as antioxidants, suchas dithiocarbamate, steroids, such as cortisol, cortisone,hydrocortisone, fludrocortisone, prednisone, prednisolone,methylprednisolone, triamcinolone, betamethasone, dexamethasone,beclomethasone, fluticasone or a combination thereof.

Suitable analgesic agents include, but are not limited to,acetaminophen, bupivicaine, fluocinolone, lidocaine, opioid analgesicssuch as buprenorphine, butorphanol, dextromoramide, dezocine,dextropropoxyphene, diamorphine, fentanyl, alfentanil, sufentanil,hydrocodone, hydromorphone, ketobemidone, levomethadyl, mepiridine,methadone, morphine, nalbuphine, opium, oxycodone, papavereturn,pentazocine, pethidine, phenoperidine, piritramide, dextropropoxyphene,remifentanil, tilidine, tramadol, codeine, dihydrocodeine, meptazinol,dezocine, eptazocine, flupirtine, amitriptyline, carbamazepine,gabapentin, pregabalin, or a combination thereof.

Kits

In various embodiments, a kit is provided that includes osteograft 30 ina first compartment. A second compartment may include a plurality ofplugs 62 comprising demineralized bone and having a polygonalcross-sectional configuration configured for disposal in one of recesses60 and a plurality of plugs 62 comprising demineralized bone and havinga circular cross-sectional configuration configured for disposal in oneof recesses 60. A third compartment may include a biodegradable carrierand the growth factor and any other instruments needed for theimplanting osteograft 30. A fourth compartment may include gloves,drapes, wound dressings and other procedural supplies for maintainingsterility during the implanting process, as well as an instructionbooklet. A fifth compartment may include additional tools forimplantation (e.g., drills, drill bits, bores, punches, etc.). Each toolmay be separately packaged in a plastic pouch that is radiationsterilized. A sixth compartment may comprise an agent for radiographicimaging or the agent may be disposed on the allograft and/or carrier tomonitor placement and tissue growth. A cover of the kit may includeillustrations of the implanting procedure and a clear plastic cover maybe placed over the compartments to maintain sterility.

It will be apparent to those skilled in the art that variousmodifications and variations can be made to various embodimentsdescribed herein without departing from the spirit or scope of theteachings herein. Thus, it is intended that various embodiments coverother modifications and variations of various embodiments within thescope of the present teachings.

What is claimed is:
 1. An osteograft comprising: a body comprisingcortical bone extending along an axis between a first end and a secondend and including an outer surface configured to engage host bone of apatient, the body including at least one recess extending transverse tothe axis into the outer surface configured for disposal of an insert;and at least one insert comprising demineralized bone disposed in the atleast one recess.
 2. An osteograft as recited in claim 1, wherein the atleast one recess extends perpendicular to the axis.
 3. An osteograft asrecited in claim 1, wherein the at least one insert comprises a plug. 4.An osteograft as recited in claim 1, wherein the at least one insertcomprises a strip.
 5. An osteograft as recited in claim 1, wherein theat least one recess has a circular cross-sectional configuration and theat least one insert has a polygonal cross-sectional configuration.
 6. Anosteograft as recited in claim 1, wherein the at least one insertcomprises whole or partially demineralized cortical or cancellous boneand has a maximum width that is greater than a maximum width of the atleast one recess, and the at least one insert is movable between a firstconfiguration in which the at least one insert deforms to facilitateinsertion into the at least one recess and a second configuration inwhich the at least one insert expands to retain the at least one insertin the at least one recess.
 7. An osteograft as recited in claim 1,wherein the at least one insert comprises cancellous bone and has amaximum width that is greater than a maximum width of the at least onerecess, and the at least one insert is movable between a firstconfiguration in which the at least one insert deforms to facilitateinsertion into the at least one recess and a second configuration inwhich the at least one insert expands to retain the at least one insertin the at least one recess.
 8. An osteograft as recited in claim 1,wherein the at least one insert is press fit into the at least onerecess.
 9. An osteograft as recited in claim 1, wherein at least aportion of the body is surface demineralized to promote chemical orcohesive bonding or mechanical press fit between the body and the atleast one insert.
 10. An osteograft as recited in claim 1, wherein thebody comprises an allograft and the at least one insert comprises bonematerial obtained from the patient.
 11. An osteograft as recited inclaim 1, wherein the at least one recess comprises a plurality ofrecesses that are spaced apart from one another and the at least oneinsert comprises a plurality of inserts.
 12. An osteograft as recited inclaim 1, wherein the outer surface of the body comprises an uppersurface and a lower surface opposite the upper surface, and the at leastone recess comprises a plurality of spaced apart recesses in the uppersurface and a plurality of spaced apart recesses in the lower surface.13. An osteograft as recited in claim 1, wherein the outer surface ofthe body comprises an upper surface and a lower surface opposite theupper surface, and the at least one recess comprises a plurality ofspaced apart recesses disposed circumferentially about the upper surfaceand a plurality of spaced apart recesses disposed circumferentiallyabout the lower surface.
 14. An osteograft as recited in claim 1,wherein the outer surface of the body comprises an upper surface and alower surface opposite the upper surface, the at least one recesscomprises a plurality of spaced apart recesses in the upper surface anda plurality of spaced apart recesses in the lower surface, and each ofthe recesses in the upper surface is coaxial with a respective recess inthe lower surface.
 15. An osteograft as recited in claim 1, wherein thebody comprises an upper surface and a lower surface opposite the uppersurface, the body includes an inner surface defining an openingextending through the upper and lower surfaces, and the at least onerecess comprises a plurality of spaced apart recesses disposed about theupper surface, a plurality of spaced apart recesses disposed about thelower surface and a plurality of spaced apart recess disposed about theinner surface.
 16. A kit comprising: an osteograft having a bodycomprising cortical bone extending between a first end and a second endalong an axis and including an outer surface configured to engage hostbone of a patient, the body including upper and lower surfaces and aninner surface defining an opening extending through the upper and lowersurfaces, the upper and lower surfaces each comprising a plurality ofrecesses extending transverse to the axis into the outer surface, theinner surface comprising a plurality of recesses extending parallel tothe axis into the inner surface, the recesses each having a circularcross-sectional configuration; a plurality of plugs comprisingdemineralized bone and having a polygonal cross-sectional configurationconfigured for disposal in one of the recesses; and/or a plurality ofplugs comprising demineralized bone and having a circularcross-sectional configuration configured for disposal in one of therecesses.
 17. A kit as recited in claim 18, wherein the recesses areuniform and each have a maximum width that is greater than a maximumwith of the plugs having a circular cross-sectional configuration, themaximum width of the recesses being less than a maximum width of theplugs having a polygonal cross-sectional configuration.
 18. Anosteograft comprising: a body comprising cortical bone extending betweena first end and a second end along an axis and including an outersurface configured to engage host bone of a patient, the body comprisingan upper surface and a lower surface opposite the upper surface, thebody including an inner surface defining an opening extending throughthe upper and lower surfaces, the upper and lower surfaces eachincluding a plurality of recesses each having a circular cross-sectionalconfiguration and extending perpendicular to the axis into the outersurface disposed circumferentially about the upper and lower surfaces,the inner surface including a plurality of recesses each having acircular cross-sectional configuration and extending parallel to theaxis; and a plurality of plugs comprising demineralized bone each havinga circular cross-sectional configuration disposed in one of therecesses, wherein the inner and outer surfaces are surface demineralizedbefore the plugs are disposed into the recesses to promote chemical orcohesive bonding or mechanical press fit between the body and the plugs.